Real Doctors, Fake Medicine?

Dr. David Kallmes’s medical degree is real. But one of his treatments for spinal fractures might not be.

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Kallmes performs vertebroplasty, a surgery he has helped to develop and standardize, that involves injecting medical cement into the fractured bone to stabilize the fractured area and relieve pain. He says he gets great results from his patients, and teaches the method to other doctors at conferences.

But here’s the thing: he has no idea why vertebroplasty works. So a few years ago, he decided to test it against a placebo. Kallmes found that pretending to perform vertebroplasty – making it seem like he was injecting a needle into the spine but without the cement – had similar effects. About 40 percent of both groups experienced immediate relief from pain after the surgery. He published his results in the New England Journal of Medicine.

So even though Kallmes’s research put the procedure into question, the practice continues: more than 14,000 patients received vertebroplasties last year.

Most of us would like to think the medicines and treatments we take – and pay for – are grounded in solid science, that our doctors know exactly what they’re doing when they prescribe them. But there’s consistent proof that placebos work just as well as some medical treatments, and it isn’t just because of a positive attitude.

Until recently, the “placebo effect” wasn’t taken seriously by the medical establishment. But one researcher, Ted Kaptchuk, has decided to make it the focus of his work. “I kept seeing things that were not explainable by my training,” said Kaptchuk, who directs the Center for Placebo Studies at Harvard Medical School.

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Kaptchuk had an unusual trajectory to the medical research field. He was the founder of the Students for Democratic Society at Columbia University, and then quit when he thought it became too radical. He studied and practiced Chinese medicine and acupuncture and lived in Asia for years.

He noticed that patients throughout his practice would get better from their interactions with the medical system, and the belief that they were being helped, even if the medicine’s impact was difficult to track.

He started to study this mechanism – the placebo effect – and the endorphins, the body’s natural painkillers, that the body releases when it happens. He had a theory there was more to it than blind faith: a neurological reason, and maybe a genetic reason.

In one of the most revealing studies on this phenomenon, published back in 1978, researchers divided patients into three groups after a dental surgery and gave them each a different treatment: morphine (a painkiller), salt water (a placebo), and naloxone (a chemical that blocks endorphins). That third group didn’t get the placebo effect.

“It was the first time that we [could see] a biology, a neurobiology of placebo effects,” Kaptchuk said. “Patients were not making this up in their heads.”

And while the findings were now backed by evidence, the pain-killing endorphins and response to placebos actually come from a less measured place. Kaptchuk said it’s the ritual of medicine – seeing a doctor, planning a treatment – that triggers the brain into healing itself.

“I’ll be quite simple and say what I think I’m doing is quantifying and making the art of medicine a science,” he said.

EDITOR’S NOTE 4/13/16

The text has been edited to clarify Dr. Kallmes’s role in developing the vertebroplasty procedure. He did not single-handedly develop the procedure, as the original text may have implied, nor did he inject the cement himself.

The article also said that that vertebroplasty and placebo patients experienced immediate relief after their surgeries, when, in fact, it was about a 40 percent success rate for patients in both groups. The text has been updated and clarified.

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